HomeMy WebLinkAboutELEVATION CERTIFICATEU.S. DE
Federal
National
Copy
'MENT OF HOMELAND S�r_-�;RITY �' OMB No. 1660-0008
gency Management Agenc _ . - Expiration Date: November 30, 2018
Insurance Program
ANNIM ELEVATION CERTIFICATIfq
Important: Follow the instructions on pages 1-9. LE
wis levlation' Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A — PROPERTY INFORMATION
Ing
FOR INSURANCE COMPANY USE
Al. Buil Owner's Name
Policy Number.
GARY & QORIS HOMAN
A2. Buil ng Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box o.
2035 NE LES BLVD.
City I' State ZIP Code
ENSEN BEACH FLORIDA 34957
A3. Pro o'erty Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 35 NI TTLES ISLAND PROJECT SECTION 1
A4. Buil; ing Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Lati'I de/Longitude: Lat. 27°17'10" Long. 80°12'49" Horizontal Datum- ❑ NAD 1927 ® NAD 1983
A6. Aft h at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Buil ing Diagram Number 113
A8. For building with a crawlspace or enclosure(s):
a) quare footage of crawlspace or enclosure(s) N/A sq ft
b) umber of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A
c) otal net area of flood openings in A8.b N/A sq in
d) ngineered flood openings? ❑ Yes X No
A9. For building with an attached garage:
a) quare footage of attached garage 236 sq ft
b) umber of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) otai net'area of flood openings in A9.b N/A sq in
d) Engingered flood openings? ❑ Yes ® No
". , aECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NF P Community Name/& Community Number
B2. County Name
B3. State
UNINC RP 120285 '
ST. LUCIE
FLORIDA
B4. Ma � Panel
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood
B9. Base Flood Elevation(s)
Nu bar
2 4 \ L
Date
Effective/
Revised Date
Zone(s)
(Zone AO, use Base Flood Depth)
J
o7_1(i. 1.I7-
vZI��1 %-z
A
B10. I�� dicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source:
B11. dicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 • ElOther/Source:
B12. Its the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No
esignation Date: N/A ❑ CBRS ❑ OPA
FEMA jl rm 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
S
ELEVATION CERTIFICATE" --
OMB No. 1660-0008
Frnirnfinn nnfa• Nnvamhor Zn 13n-lfl
IMPORTANT: In these spaces, copy the corresponding information from Section �: V "
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route. and Box No.
Policy Number.
2035 NETTLES BLVD.
Ciy' State ZIP Code
JENSEN BEACH
Company NAIC Number
FLORIDA 34957
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: 94 77 A04 FLDT Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.0 ® feet ❑ meters
b) Top of the next higher floor N/A ❑ feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) NIA ❑ feet ❑ meters
d) Attached garage (top of slab) 5•0 ® feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A feet meters
(Describe type of equipment and location in Comments) ❑ ❑
f) Lowest adjacent (finished) grade next to building (LAG) 4.5® feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4.6 ® feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support N/A ❑ feet ❑ meters
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
/ certify that the information on this Certificate represents my best efforts to interpret the data available. / understand that any false
statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number 656-203-01-UC
EARLE R. STARKEY 004459
Title
PROFESSIONAL LAND SURVEYOR
Company Name
ACCURIGHT LAND SURVEYING INC.
Address=�
1501 DECKER AVENUE #419
City State ZIP Code
STUART 10/04/2018
FLORIDA 34994 PLS #4459
Signature Date Telephone Ext.
18 772-286-7694
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building,owner.
Comments (including type of equipment and location, per C2(e), if applicable)
FEMA Form 086-0-33 (7/15) Replaces all previous editions. ' Form Page 2 of 6